January 23, 2018
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Most infection specialists do not advise shortest course of antibiotics

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Most infection specialists appear to be ignoring a key component of antimicrobial stewardship.

In a survey of more than 800 health care professionals — including nearly 82% who were either clinical microbiologists or infectious disease specialists — only around one-third advised the shortest duration of antibiotic therapy to their patients, researchers reported recently in the Journal of Antimicrobial Chemotherapy.

In a finding that researchers called “quite unexpected,” being a member of an antimicrobial stewardship team — 73% of respondents — was not associated with advising short durations or a willingness to shorten treatment durations.

“Using the shortest possible duration of antibiotic treatment is a key component of responsible antibiotic use, with some studies suggesting that shortened durations can limit the emergence of bacterial resistance, without compromising clinical outcomes,” the researchers wrote. “Most antibiotic stewardship guidelines recommend that stewardship teams implement guidelines and strategies to promote the shortest effective duration of antibiotic therapy. No study has, however, explored the current practices of infection specialists, who are often members of an antibiotic stewardship team, regarding duration of antibiotic therapy.”

Between September and December 2016, researchers from the European Society of Clinical Microbiology and Infectious Diseases and the French Infectious Diseases Society surveyed health care professionals who provide advice on antibiotic prescriptions to colleagues at least every week about their recommendations.

“The questionnaire included 15 clinical vignettes corresponding to common clinical cases with favorable outcomes; part A asked about the antibiotic treatment duration they would usually advise to prescribers and part B asked about the shortest duration they were willing to recommend,” the researchers wrote.

“The participants were only informed that the survey was about duration of antibiotic treatments and so they were not aware while completing part A on usual practices that they would subsequently be asked in part B about willingness to shorten durations.”

In all, 866 respondents from 58 countries were included in the study, mostly from four European countries: France (19.1%), the United Kingdom (15.7%), Spain (9.5%) and Germany (9.1%). Among them, 58.7% were infectious disease specialists and 22.8% were clinical microbiologists.

Of the respondents, 36.2% recommended a short duration in more than 50% of the vignettes and 4.1% recommended a short duration in more than 75% of them. Among 749 respondents who responded to between eight to 15 vignettes, short durations of antibiotics were recommended in 42.7% of cases. Approximately 47.1% of eligible respondents said they were willing to shorten treatment duration for at least 50% of the clinical vignettes.

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“It is encouraging that almost half of the participants were ready to shorten durations of treatment, as it suggests that these infection specialists, who are frequently antibiotic stewards, are ready to promote strategies aimed at reducing duration of antibiotic therapy,” the authors wrote. “Nevertheless, our results also show that the rest of the participants, who represent the majority, should be the target of specific educational and awareness initiatives, if they are to act as leaders and role models to promote such a strategy.” – Gerard Gallagher

Disclosures: The authors report no relevant financial disclosures.